Inspection on 06/12/06 for Nascent House

This inspection was carried out on 6th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nascent House 03/12/08

Nascent House 25/01/06

Nascent House 27/09/05

Nascent House 25/02/05

Nascent House 17/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Nascent House London Road Apsley Hemel Hempstead Hertfordshire HP3 9ST Lead Inspector Alison Jessop Unannounced Inspection 6th December 2006 10:00 Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nascent House Address London Road Apsley Hemel Hempstead Hertfordshire HP3 9ST 01442 251366 01442 251366 nascenthouse@druglink.ltd.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Druglink Limited Ms Jeanette Mandiville Care Home 8 Category(ies) of Past or present alcohol dependence (8), Past or registration, with number present drug dependence (8) of places Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 8 people with drug or alcohol dependence. Date of last inspection 25th January 2006 Brief Description of the Service: Nascent House is a Stabilisation Unit providing short-term accommodation and therapeutic support to up to eight service users with past or present alcohol or drug dependency. The house is in keeping with the local community and is situated in Apsley, close to a small selection of local shops. It is also allocated near to the town of Hemel Hempstead, which has excellent shopping and leisure facilities. It provides eight single occupancy rooms. The home retains a waiting list and reports a high retention and success rate. The current weekly charge for the home is £556.50. A copy of the inspection report can be obtained from the office. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried out this unannounced inspection over one day. Time was spent in the office with the manager and the staff team, records were scrutinised and feedback was gained from service users over lunch. What the service does well: What has improved since the last inspection? The chief executive of Drug link has now registered as the responsible individual with the commission for social care inspection. The hallway on entrance to the home has been redecorated and offers a clean, bright environment. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The robust admission procedure ensures that prospective service users understand the terms and conditions of the home. It also ensures that staff resources can adequately meet needs. EVIDENCE: Initial referrals are received by telephone where basic details of the prospective service user are taken. A thorough assessment is carried out where information is gained about the person and any potential risks are identified. If risks such as history of violence are identified, the person will not be accepted for the service as this could create risks to other service users and staff. The prospective service user is invited to look around the home and meet the staff and current service users prior to admission. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Although strict restrictions are in place, service users make decisions and have involvement in the day-to-day running of the home. They are also encouraged to take some responsibilities, which is in preparation for when they leave the programme. EVIDENCE: Service users are restricted in many ways however all spoken to confirm that they were aware of the restrictions before they moved to Nascent House. Household tasks are shared with service users, which helps prepare them for a life in the community. The house committee meetings enable planning of daily life in the home. Rules and restrictions provide a safe environment to service users. They also promote appropriate social skills and respect. The intense therapeutic Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 10 programme encourages the building of self-confidence and self esteem. One service user stated ‘the staff are very caring, I find it difficult to trust people, however they never seem to let you down. They are also very firm if boundaries are crossed.’ Although staff are aware of the need to carry out individual risk assessments as part of the care planning process, those observed had not been carried out routinely. Random urine and breath tests are carried out and should a positive result be found the service user is immediately evicted from the programme. The strict regime reflects the success rate, as service users are aware that this may the only opportunity they will get to overcome their addiction. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff at Nascent House, ensure that service users participate and engage in the local community. This prepares them when they move on as it raises awareness of acceptable social skills. EVIDENCE: The service users are individually given the choice of whether they would like to celebrate Christmas. As this is the most difficult time for addict’s service users are informed in writing well in advance of the extra rules and restrictions at this time of year. The house is open on boxing day for families and friends to visit however no outings or visits are permitted during the times considered to be a high risk of relapse. No one has left the programme over the Christmas and New Year period for the past two years, this demonstrates a highly Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 12 successful programme. Service users are given a Christmas present from the house and those that choose participate in cooking Christmas lunch. The home has connections with the local church, which donates introduction packs, which contain items such as toiletries and small items to make their room look homely. They also donate moving on packs. Service users had recently attended the church Christmas fete. Other activities that are held on a regular basis are leaving parties when someone completes the programme where the service user is awarded a certificate of success. Service users visit the gym on a weekly basis and other therapeutic activities such as art therapy and African drumming are provided as part of the programme. A day trip on a canal boat and a future outing to the theatre has been arranged. On the day of the inspection, the afternoon therapy session was relaxation and Auricular Acupuncture. A member of staff who has completed training in this complementary therapy carries this out. Service users are given the choice as to whether they would like to receive this. Service users lie on large cushions in the lounge whilst relaxation tapes are played. Service users with staff support decide a weekly menu and each person has responsibility of cooking the meal of their choice once a week. Service users invited the inspector to join them for lunch where Scrambled egg on toast was served followed by a homemade birthday cake, which was baked by a service user to celebrate a birthday. The homely, family atmosphere around the dining table is another important part of the programme and the service user was delighted and happy to be sharing her birthday with the other residents and staff. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The knowledge and experience of the staff offers a meaningful, supportive environment to the emotional well being of service users. Staff are nonjudgemental in their approach, which encourages service users to deal with long standing issues that they need to approach in order to move forward. EVIDENCE: Each service user has a care plan, which is written on entry to the programme. This is reviewed following twelve weeks. Goals are set and are monitored by both the staff and service user. Service users write a journal each day and staff maintain daily progress notes. As the programme progresses the care plan includes the implementation of day, overnight and weekend visits, and identifies any vocational interests. Preparation for moving on is seen as a very important process and can reduce the risk of relapse. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 14 Procedures relating to medication were generally satisfactorily however it is recommended that where service users self-medicate, they should where possible sign their medication administration sheet claiming responsibility. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is explained to service users and service users are encouraged to complain appropriately as part of the programme again assisting them to act appropriately when they move on. EVIDENCE: No complaints have been received by the home since the previous inspection. Several compliments have been received. A copy of the Hertfordshire Protection of Vulnerable Adults procedure is available in the office. No referrals to POVA have been made. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Nascent House offers a homely and therapeutic environment to its service users, providing a positive family atmosphere, encouraging service users to complete the programme. EVIDENCE: The home has undergone some redecoration in the hallway with further work outstanding. The new décor offers a bright, clean entrance to the home. New bathrooms and toilets are now installed and offer clean, hygienic bathroom facilities. Service users bedrooms look comfortable and homely and offer some privacy to service users. The ground floor bedrooms have separate bathroom and toilet facilities and are for female service users only. A door alarm is fitted to the door, which activates on entry to this area. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The dedicated staff team are enthusiastic and appear to take great pride in their work. This creates a positive atmosphere to service users, who can at times be very vulnerable. EVIDENCE: Staff spoken to confirm they receive formal one to one supervision with their manager and group meetings are held regularly. Staff said they feel very supported in their role. Service users spoken to also confirmed that they felt supported by staff that have expertise, and knowledge of their issues. Each worker has the responsibility of a particular role within the house. One member of staff on duty was responsible for ensuring that there is a comprehensive training plan. Staff appear to receive a lot of specialised training and certificates are displayed in the hallway. An audit of mandatory Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 18 training is being carried out and training resources for future training needs are being identified. Records relating to recruitment are satisfactory. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in an open, positive and inclusive manner, however with very strict rules and boundaries. This appears to contribute to the high level of completion and success rates. EVIDENCE: The manager is very clear about the rules and boundaries within the home, which appears to be effective. The weekly residents committee meeting ensure that service users are able to air their views and discuss any concerns. Interaction between the manager and service users was positive and service users appeared to respect the style of management within the home. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 20 Service users collect their weekly income and are expected to pay a contribution towards their rehabilitation programme. They can keep their personal allowance and are encouraged to manage their weekly budget effectively. Money that is above the weekly allowance is stored securely by staff and records are maintained. Records relating to health and safety including fire safety are satisfactory. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 2 x LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13 (4)(a)(b) & (c) Requirement Risk assessments must be carried out routinely as part of individual care plans. Timescale for action 06/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is recommended that service users who self medicate sign the medication administration record. Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nascent House DS0000019478.V323313.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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